Prevalence of active trachoma infection and associated factors post‐war resettled population in raya kobo districts, North East Ethiopia: A community‐based cross‐sectional study in 2022

Active trachoma infection poses a serious threat to public health, particularly for those who live in an unprivileged area and has practiced open‐field defecation. This study aimed to estimate the prevalence of active trachoma infection and associated factors in the post‐war resettled population in Raya Kobo district, North East Ethiopia: a community‐based cross‐sectional study in 2022.

providers should focus on information dissemination on proper latrine utilization, and washing the face regularly to prevent active trachoma infection is highly recommended.

K E Y W O R D S
active trachoma, displaced population, Ethiopia

| INTRODUCTION
Chlamydia trachomatis is an infectious eye disease caused by Chlamydia trachomatis, an obligate intracellular bacterium that causes follicular conjunctivitis, superficial keratitis, and corneal and finally caused scarring. 1,2 Active trachoma infection is characterized by severe corneal abrasion, increased inflammation, and scarring of tarsal conjunctivitis due to insufficient secretion of biomarkers for ocular diseases and neurodegenerative condition of eyes. 3,4 Pathologically, persistent and recurrent eye infections cause inflammation of the outer cornea and ocular surface, which fails to connect the sensory and motor nerves for correct imaging of the eyes. 5,6 Globally, active trachoma is the leading infectious cause of blindness and is considered the cause of visual impairment in 1.9 million people. 7,8 Around 50 million individuals worldwide have trachoma, and 3-10 million of them go blind as a result of the infection 9 with annual economic lost $2.9 and $5.3 billion. 9,10 According to the World Health Organization (WHO) 2020, more than 88% of the 157.7 million people living in the area with active trachoma sites were from African countries with more than 44.2%. 11,12 The WHO promotes a multifaceted "SAFE" method for trachoma prevention, which includes multiple components for reducing the burden through antibiotic distribution and environmental sanitation, and in 2021 achieved antibiotic coverage of 44%. 12,13 A 10% post-surgery relapse was reported despite this success with more than 80% chemo-prophylaxis coverage and 47.6% surgical intervention in highly active trachoma mapping zones. 14,15 However, in Ethiopia, the combined prevalence of active trachoma was found to be 26.9% in school-age children and 4.1% in the adult population, according to recent meta-analysis findings 16,17 and the problem is exacerbated by a lack of clean water, living in in a health center, and family size. 6,18 More than 1.4 million people were forced to reside in refugee camps during the battle against the Tigray People Liberation Front (TPLF) and the central government of Ethiopia, particularly the frontline of the war of Amhara and Afar areas, where 600,000 people died. 19 As a result, the community was forced to move, which made them more vulnerable to communicable diseases including active trachoma, infection, food insecurity, and subpar medical care. Therefore, our study aimed to estimate the post-war burden of active trachoma among the displaced population in Raya Kobo District in North Wollo Zone, North East Ethiopia.

| Methods and study setting
This study was conducted in Raya Kobo Woreda, located in Amhara Region. which is located 552 and 365 km from the regional capital city Bahir Dare and Addis Ababa, respectively. 20 The Amhara region, more specifically the North Wollo zone, has already lost more than 2347 healthcare facilities that give service to the catchment population.

| Study design and period
The community-based cross-sectional study was employed among randomly selected 14 displaced slums/shantytowns in Raya Kobo district, North East Ethiopia.

| Study population
All individuals who reside from February 16th to March 30th, 2023 among randomly selected residents in Raya Kobo District post-war on TPLF.

| Inclusion criteria
All individuals who had lived in Raya Kobo district post-war randomly selected households were interviewed for at least a month and included in this study.

| Sample size determination
The sample size was calculated using a single proportion formula since there is no research about TT infection post-war in northern Ethiopia about TT infection with considering the following parameters and the formula of the single population proportion

| Data quality assurance
The quality of data was ensured at the point of data collection and data entry. Emphasis was given to designing questionnaires on the objective of the study and explained to data collectors. A pretest was undertaken on 5% 25 of our final samples at the Habru site with the prepared structured questionnaire before the actual data collection started and the amendment was made to the format.

| Data processing and analysis
The collected data were entered and cleaned using Epi Info software version 7, and then exported to STATA (SE) R/14) data for further analysis. Frequency and percent were computed through bivariable analysis to obtain summary statics. Bi-variable analysis between the dependent and independent variables was performed separately using logistic regression. In addition, a chi-square analysis was performed for each variable to assess whether statistical significance was reported among categorical variables. The strength of association between dependent variables and independent variables is expressed as an adjusted odds ratio (OR) within 95% confidence interval (CI).

| History of eye infection
Of the 602 participants in total, 58 (or 9.6%) had a history of eye infection, and 42 (or 7.1%) of those had recurrent infections.
However, 13 (6.3%) and 18 (3%), respectively, of the responders   17.85---24.37). This report is high than compared to previous finding 6% in Dangilla, 7 11.8% in Metema, 26 and 6.65% in Brazil. 27 The major reason for the discrepancy may be our study report was compiled post-war among displaced and resettled populations, which may increase the estimation in addition to differences in the sample size and environmental characteristics of the comparison groups.
Conversely, the final report of our study is also most consistent with previous findings with 17.2% in Gambella, 28 18% in Dembia, 29 18.6% in Dera Woreda, 30 17.5% in Howassa, 11 and 17.5% in Sudan. 11 Whereas, our study finding is lower than 23.4% reported in Oromia, 23 26.9% meta-analysis in Ethiopia, 16 37.9%in Wolyita, 31  increases, there seems to be a challenge in implementing the SAFE strategy's "F" component, and there is also a tendency to forget about active trachoma infections due to a lack of awareness of the possibility that increased nasal and ocular discharge will result in an increased risk of transmission.
In a multivariable analysis of this study, individuals who practice regularly washed face were 77% (AOR = 0.23, 95%CI; 0.127--0.43) times preventing the likely hood of getting active trachoma infection as compared with the counter group. This is consistent with findings reported in Awi-Zone, Southwest Ethiopia, 35,36 Howassa City, 11 and South Sudan. 37 This might be significantly associated with the fact that an unclean face could be more likely to spread ocular secretions infected with C. trachomatis and highly susceptible to the risk of developing. 15 In this study, we found that having access to latrine use reduces

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
The data set analyzed for this study is from the corresponding author on reasonable request.

ETHICS STATEMENT
The

TRANSPARENCY STATEMENT
The lead author Fassikaw Kebede affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.